腹腔镜成人胆总管囊肿手术五例临床分析

Laparoscopic surgery of adult choledochal cyst:Experience with 5 cases

目的探讨成人先天性胆总管囊肿腹腔镜囊肿切除+肝管空肠Roux-en-Y吻合胆道重建微创手术的可行性和近期疗效。方法选择5例成人先天性胆总管囊肿患者(均为女性),在腹腔镜下先行胆囊切除,再从扩张囊肿的中部横断囊肿前壁吸出胆汁,将囊肿壁全层逐渐彻底切除,然后实施肝管空肠Roux-en-Y吻合胆道重建微创手术。结果 5例患者均顺利完成胆总管囊肿腹腔镜微创手术。手术时间4～6h(平均为5h),出血量50～100ml,平均住院时间10d。1例患者术后发生一过性微量胆漏。5例先天性胆总管囊肿患者随访10～36个月,无肠粘连、梗阻和吻合口狭窄发生,无胆管炎和结石发生,肝功能检查指标均在正常范围内。结论成人先天性胆总管囊肿腹腔镜囊肿切除+肝管空肠Roux-en-Y吻合微创手术是一种安全可靠的方法,具有创伤小、恢复快、术后近期疗效满意和手术技巧要求高等特点。

Objective To investigate the feasibility and short-term clinical outcome of laparoscopic surgery for adult choledochal cyst, involving cyst resection and hepatoenterostomy by the Roux-en-Y method. Methods Five female patients with congenital choledochal cyst received laparoscopic cyst resection and hepatoenterostomy by the Roux-en-Y method. Briefly, gallbladder was removed at first, then bile was sucked from the anterior wall of the cyst. Subsequently the cyst wall was resected radically, while biliary reconstruction was done by the Roux-en-Y method. Results All of the 5 patients underwent laparoscopic cyst resection and hepatoenterostomy successfully. The average operative time was 5 hours （ 4 -6 hours ）. The amount of bleeding was 50 - 100 ml,. The average hospital stay was 10 days. One patient had mild bile leakage after operation. A follow-up of 10 -36 months revealed no intestinal adhesion and obstruction, nor anastomotic stenosis, cholangitis and stones in the patients. Postoperative liver function tests showed nothing abnormal. Conclusion Laparoscopic adult choledochal cyst resection and hepaticojejunostomy are safe and reliable operative procedures. They are characterized by less trauma, quicker recovery, and satisfactory curative effect.